o A person should never have glucose in their urine. When women are pregnant, you may find a trace in the second half of pregnancy; this is usually considered normal if there are no other symptoms. The kidneys may not be able to handle the high levels of blood glucose anymore. Screening test o 1 hr. / 3 hr. glucose tolerance test (GTT): she can eat whatever she wants; test her blood when she first comes in; give sugary 50 gram glucola ; redraw blood and look to see if values are 130-140 mg/dl or less . o If positive, bring her back for a 3-hr OGTT: she can eat whatever she wants day before. Fasting during night. Take fasting glucose. Give her the glucose drink: 100 gram glucola . Take values over next three hours . Looks to see if values come down within ranges. If they don’t come down, she is diagnosed with GDM. o HbA1c-doesn’t show adequately show the picture of a woman’s glucose control during pregnancy. We do not do the HbA1c test on a pregnant women.
Care o Goal = healthy pregnancy for mom and baby o Team approach: may need to see a perinatologists, nurtritionist, endocrinologist o If she has GDM, diet control. If diet control is ineffective, can medicate with insulin. Most of the time we will not control with oral hypoglycemic meds. o Pre-existing diabetes = insulin control o NST=nonstress testing is usually begun weekly at about 28 weeks to monitor fetal growth for IUGR or macrosomia, olighydramnios, or poorly controlled BG exists, testing may begin as early as 26 weeks and may be done more often. NSTs are increased to twice weekly at 32 weeks’ gestation. If the NST is nonreactive, a fetal biophysical profile or contraction stress test is performed. NST determines the wellbeing of the baby o U/S=determine how baby is doing o During labor, we give her glucose and fluid and insulin if the pt. is a insulin-dependent diabetic o Post-partum=watch the baby for hypoglycemia; mom’s insulin needs will decrease quickly after birth Care of the Woman with Anemia (Iron Def. and Folic Acid Def.) Psuedoanemia from increased blood volume d/t increase in plasma volume. Normal female HGB: 12-16. For a non-pregnant pt., anemia=less than 12 g/dl. For a pregnant woman, anemia=less than 10.5 g/dl. Iron Deficiency Most common medical complication of pregnancy Ask about fatigue, SOB A pregnant woman needs 1000 mg more of iron than non-pregnant woman Causes: diet, the baby draws from her Risks: infection, low birth weight, preterm, hemorrhage, fatigue Tx.: prenatal vitamin, may add iron supplement, foods with iron in them; teach about constipation with iron supplement; increase absorption by consuming sources of Vitamin C such as Orange Juice Folic Acid Deficiency Most common cause of megaloblastic anemia Without enough folic acid, cells don’t divide effectively, die early
Folate—water soluble vitamin 400mcg/day; more if pregnant with multiples Tx.: food sources and prenatal vitamin Sickle Cell Anemia Recessive-autosomal